Prognostic utility of inflammation-based biomarkers, neutrophil–lymphocyte ratio and change in neutrophil–lymphocyte ratio, in surgically resected lung cancers

Abstract

BACKGROUND/OBJECTIVE: Given the poor overall survival (OR) and progression-free survival (PFS) rates for lung cancers managed with surgical resection, there is a need to identify the prognostic markers that would improve the risk stratification of patients with operable lung cancer to inform treatment decisions. We investigate the prognostic utility of two established inflammation-based scores, the neutrophil–lymphocyte ratio (NLR) and the change in neutrophil–lymphocyte ratio (ΔNLR), throughout the operative period in a prospective cohort of patients with lung cancer who underwent surgical resection. METHODS: Demographic, clinical, and treatment details for 345 patients with lung cancer who underwent surgical resection between 2000 and 2019 at multiple centers across Melbourne, Victoria (Australia), were prospectively collected. Preoperative NLR and ΔNLR were calculated after which Cox univariate and multivariate analyses were conducted for OS and PFS against the known prognostic factors. RESULTS: Both univariate and multivariate analyses showed that preoperative NLR >4.54, as well as day 1 and day 2 postoperative NLR ( P < 0.01), was associated with increased risk for postoperative mortality (hazard ratio 1.8; P < 0.01) and PFS ( P < 0.05), whereas ΔNLR was not a significant predictor of OS or PFS. CONCLUSION: Elevated NLR among patients with lung cancer who underwent surgical resection was prognostic for poor OS and PFS, whereas ΔNLR was not found to be prognostic for either OS or PFS. Further research may yet reveal a prognostic value for ΔNLR when compared across a greater time period.

Albumin‑bilirubin grade is an independent prognostic factor for small lung cell cancer

“…Univariate and multivariate analysis for OS. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------95% CI 95% CI --------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- cancer, according to previous reports (30)(31)(32). NLR showed predictive effect of PFS in univariate analysis and PLR showed predictive effect of both PFS and OS.…”

Prognostic score and sex-specific nomograms to predict survival in resectable lung cancer: a French nationwide study from the Epithor cohort database

“… 20 , 21 Systemic inflammation on one side, patient nutritional status or fitness on the other, represent two main lines of research in this setting, increasing CRP or neutrophil/lymphocyte ratios, as well as lower BMI, albuminemia or prealbuminemia, sarcopenia or weight loss being associated with worse prognosis. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 In patients with metastatic NSCLC, some host-related characteristics, including fitness and resting energy expenditure have been shown to be associated with response to immune checkpoint inhibitors, underlining the complex interplay between host, tumor and treatments. 30 , 31 It seems evident that taking into account host characteristics together with tumor features should help in better assessing recurrence risk after treatments, especially surgery, and indicating perioperative treatments, in the era of immune-check point inhibitors.…”

“… 18 Ideally, availability of features easy to obtain and reproducible, could represent a major advance to predict outcome, and, in particular risk of recurrence and death. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 This would allow proposing perioperative treatment in a more personalized manner in order to expose to possibly toxic medications only patients likely to benefit from their administration and to avoid heavy treatments in patients less likely to develop recurrence after surgery. 18 , 32 , 33 , 34 , 35 , 36 In the present study, based on a nationwide prospectively collected database, Epithor, whose project is carried out under the auspices of the French Society of Thoracic and Cardiovascular Surgery, we developed a prognostic score and related nomogram based on nine patient and tumor-related variables.…”